title: Aircraft noise and cardiovascular disease near Heathrow airport in London: small area study.
abstract: OBJECTIVE
  To investigate the association of aircraft noise with risk of stroke, coronary heart disease, and cardiovascular disease in the general population.
  
  
  METHODS
  Small area study.
  
  
  METHODS
  12 London boroughs and nine districts west of London exposed to aircraft noise related to Heathrow airport in London.
  
  
  METHODS
  About 3.6 million residents living near Heathrow airport. Risks for hospital admissions were assessed in 12 110 census output areas (average population about 300 inhabitants) and risks for mortality in 2378 super output areas (about 1500 inhabitants).
  
  
  METHODS
  Risk of hospital admissions for, and mortality from, stroke, coronary heart disease, and cardiovascular disease, 2001-05.
  
  
  RESULTS
  Hospital admissions showed statistically significant linear trends (P<0.001 to P<0.05) of increasing risk with higher levels of both daytime (average A weighted equivalent noise 7 am to 11 pm, L(Aeq),16 h) and night time (11 pm to 7 am, Lnight) aircraft noise. When areas experiencing the highest levels of daytime aircraft noise were compared with those experiencing the lowest levels (>63 dB v ≤ 51 dB), the relative risk of hospital admissions for stroke was 1.24 (95% confidence interval 1.08 to 1.43), for coronary heart disease was 1.21 (1.12 to 1.31), and for cardiovascular disease was 1.14 (1.08 to 1.20) adjusted for age, sex, ethnicity, deprivation, and a smoking proxy (lung cancer mortality) using a Poisson regression model including a random effect term to account for residual heterogeneity. Corresponding relative risks for mortality were of similar magnitude, although with wider confidence limits. Admissions for coronary heart disease and cardiovascular disease were particularly affected by adjustment for South Asian ethnicity, which needs to be considered in interpretation. All results were robust to adjustment for particulate matter (PM10) air pollution, and road traffic noise, possible for London boroughs (population about 2.6 million). We could not distinguish between the effects of daytime or night time noise as these measures were highly correlated.
  
  
  CONCLUSIONS
  High levels of aircraft noise were associated with increased risks of stroke, coronary heart disease, and cardiovascular disease for both hospital admissions and mortality in areas near Heathrow airport in London. As well as the possibility of causal associations, alternative explanations such as residual confounding and potential for ecological bias should be considered.
authors.affiliation: UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Hansell
authors.forename: Marta
authors.initials: M
authors.lastname: Blangiardo
authors.forename: Lea
authors.initials: L
authors.lastname: Fortunato
authors.forename: Sarah
authors.initials: S
authors.lastname: Floud
authors.forename: Kees
authors.initials: K
authors.lastname: de Hoogh
authors.forename: Daniela
authors.initials: D
authors.lastname: Fecht
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Ghosh
authors.forename: Helga E
authors.initials: HE
authors.lastname: Laszlo
authors.forename: Clare
authors.initials: C
authors.lastname: Pearson
authors.forename: Linda
authors.initials: L
authors.lastname: Beale
authors.forename: Sean
authors.initials: S
authors.lastname: Beevers
authors.forename: John
authors.initials: J
authors.lastname: Gulliver
authors.forename: Nicky
authors.initials: N
authors.lastname: Best
authors.forename: Sylvia
authors.initials: S
authors.lastname: Richardson
authors.forename: Paul
authors.initials: P
authors.lastname: Elliott
mesh_terms: D000368:Aged; D000401:Aircraft; D059028:Airports; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009624:Noise, Transportation / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012424:Rural Population; D017062:Small-Area Analysis; D015996:Survival Rate / Q000639:trends; D013997:Time Factors